Introduction: Microvascular free flaps are a reconstructive option that allows the treatment of large and complex defects. Normally the loss of free flaps is due to arterial or venous compromise, that´s why adequate flap postoperative monitoring is essential and allows to identify vascular compromise, and perform a timely surgical reintervention, in order to achieve the salvage of the flap. Materials and methods: An exhaustive review of the literature was performed in different databases like PubMed and Cochrane, about the existing evidence on postoperative monitoring of microvascular free flaps. The terms “free flap” and “monitoring” were used for the search and articles written in English and Spanish were included. Results: Clinical monitoring is the Gold Standard for the detection of vascular compromise in a microvascular free flap. This method and the manual Doppler ultrasound are the methods of choice for flap monitoring. Other methods, such as the implantable Doppler, have higher flap recovery rates than the previous ones, although it is less cost-effective. Conclusions: Postoperative monitoring through clinical observation, the use of manual Doppler ultrasound, and other more complex methods such as implantable Doppler are monitoring methods that allow quick reintervention of flaps with vascular compromise, in order to avoid flap loss.
